Provider Demographics
NPI:1518048891
Name:CAWLEY, JILL S (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:S
Last Name:CAWLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:S
Other - Last Name:HALDEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1104 MAIN ST
Mailing Address - Street 2:SUITE M110
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2999
Mailing Address - Country:US
Mailing Address - Phone:360-695-0115
Mailing Address - Fax:360-695-3436
Practice Address - Street 1:1104 MAIN ST
Practice Address - Street 2:SUITE M110
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2999
Practice Address - Country:US
Practice Address - Phone:360-695-0115
Practice Address - Fax:360-695-3436
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR350142101YM0800X
WALW00005181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000615508Medicare PIN